#FGBlog: To feed or not to feed?

“Ethics of providing clinically assisted nutrition and hydration: current issues”

I love to eat.

I base my day around my meals and snacks.

In fact, my stomach starts to rumble at 10am despite having a full breakfast at 7am.

I’m that person who keeps snacks in their scrubs’ pockets whilst on call because I need to eat at constant regular intervals, otherwise I get “hangry”

I have never skipped a meal.

 

Food can be delicious, inventive, colourful, inspiring and so much more. Food can bring people together- it can be a time of celebration and it can be a time of mourning. For many of us, it is our innate nature to feed and to be fed. Let’s be honest- life without food would just be miserable.

 

Food is associated with so much more than just simple sustenance and survival in a person’s life. It is no surprise that the thought of depriving someone of food is considered to be inhumane, particularly for those who do not have the ability to communicate their wishes.

 

Managing nutrition in the terminally ill or the incapacitated is such a controversial area in medicine and in my experience, a poorly managed one at that. However, it is such an important issue to discuss and to be properly educated on because not only are there legal and ethical issues to consider, but also our own emotional and personal beliefs.

 

Whether we are hesitant to speak to the patient’s family; worried about being sued or struck off; or genuine concern that we are starving the patient in their last days of life, we need to ask ourselves two important questions:

  • What are we trying to achieve?
  • Who are we treating- Ourselves? The family? Or the patient?

 

Rochford has written a really beautiful summary on how to manage patients that require clinically assisted nutrition and hydration (CANH). He emphasises that the patient is the main priority and before considering CANH, we should ask ourselves the following questions about our patient:

  • What is his/her current condition?
  • What is the quality of his/her life at present (from HIS/HER perspective)
  • What is his/her awareness of the world around him/her
  • Is there any (or any significant) enjoyment in his/her life? If so, how can this be maximised?
  • Does he/she experience pain and/or distress and if so, is it appropriately managed?
  • What is his/her prognosis, if CANH were to be continued?
  • Is there any real prospect of recovery of any functions or improvement to a quality of life that he/she would value?
  • What is the prognosis if CANH were to be discontinued?
  • What end-of-life care would be provided?

 

It is important to understand the implications and complications when considering CANH. This paper provides an in depth understanding of managing CANH and honestly, every healthcare professional from the junior doctor to the senior consultant to the sister in charge should read this.

 

References:

Rochford A. Ethics of providing clinically assisted nutrition and hydration: current issues. Frontline Gastroenterology. 2021l 12: 128-132

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